Captopril and Cyclosporine Ophthalmic: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Cyclosporine Ophthalmic
Captopril
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Acute renal dysfunction, increased risk of hyperkalemia and an increased cycloSPORINE exposure
Interaction Deep Dive
Coadministration of cycloSPORINE, a P-gp substrate with captopril, a P-gp inhibitor, an angiotensin-converting enzyme (ACE) inhibitor and a potassium sparing diuretic may increase the concentrations of cycloSPORINE and may increase the risk of hyperkalemia. Adjust cycloSPORINE dosage to achieve the desired cycloSPORINE concentrations when these drugs are administered concomitantly. Use caution and control potassium levels during coadministration12. Concomitant use of ACE inhibitors and cycloSPORINE may also decrease renal function. Two reported cases involved renal transplant patients receiving enalapril concurrently with cycloSPORINE and furosemide. With discontinuation of the ACE inhibitor renal function improved. The investigators speculated that long term administration of cycloSPORINE may cause renal hypoperfusion, which in turn may activate the renin-angiotensin system for maintenance of glomerular filtration. If these conditions are true, then the introduction of an ACE inhibitor could trigger an acute deterioration in renal function 3.
Why it happens (mechanism)
Reduced angiotensin II; additive hyperkalemia; inhibition of P-gp-mediated efflux transport of cycloSPORINE
Literature reports
1 report — tap to read
a) Two reported cases involved renal transplant patients receiving enalapril concurrently with cycloSPORINE and furosemide. With discontinuation of the ACE inhibitor renal function improved. The investigators speculated that long term administration of cycloSPORINE may cause renal hypoperfusion, which in turn may activate the renin-angiotensin system for maintenance of glomerular filtration. If these conditions are true, then the introduction of an ACE inhibitor could trigger an acute deterioration in renal function 3.
Common questions
Can I take Captopril and Cyclosporine Ophthalmic together?
Acute renal dysfunction, increased risk of hyperkalemia and an increased cycloSPORINE exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Captopril and Cyclosporine Ophthalmic interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Captopril or Cyclosporine Ophthalmic need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (3)
- Product Information: NEORAL(R) oral soft gelatin capsules oral solution, cyclosporine modified oral soft gelatin capsules oral solution. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2023. DailyMed
- Product Information: SANDIMMUNE(R) oral capsules, oral solution, intravenous injection, cyclosporine oral capsules, oral solution, intravenous injection. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2023. DailyMed
- Murray BM, Venuto RC, Kohli R, et al: Enalapril-associated acute renal failure in renal transplants: possible role of cyclosporine. Am J Kidney Dis 1990; 16:66-69. PubMed
Keep reading about Cyclosporine Ophthalmic
Keep reading about Captopril
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